The Irrigation or No Irrigation in Simple Lacerations Trials

NCT ID: NCT02976480

Last Updated: 2025-02-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2025-02-22

Brief Summary

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The purpose of this study is to determine whether the irrigation or non-irrigation of a simple laceration treated in the emergency department has an effect on the subsequent rate of infection.

Detailed Description

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Background: Current guidelines recommend that lacerations be irrigated prior to their closure. However, there is very little data in the literature suggesting that simple laceration irrigation diminishes the subsequent rate of infection. Do patients benefit from this practice that involves additional time and costs?

Hypothesis Testing \& Procedure: The purpose of this double-blind randomized controlled non-inferiority study is to test the hypothesis that the non-irrigation of lacerations does not increase the rate of post-repair infection. Every adult patients presenting to the Chicoutimi's Hospital Emergency Department with a simple laceration will be identify by the triage nurse. Eligibility will subsequently be assessed by the emergency room physician according to the inclusion and exclusion criteria. Eligible and consenting patients will be randomized to either the irrigation or non-irrigation arm. Post-repair rate of infection and aesthetic appearance satisfaction will be reported.

Sample Size Determination: With the fairly liberal inclusion criteria, a 6% wound infection rate in the irrigation group is expected, which corresponds to the upper limit of the 2 to 6% range reported in the literature. Non-inferiority of non-irrigation would be accepted if the rate of infection in this group does not exceed by 4% the usual infection rate of 6% with irrigation, as previously stated. As such, for the study to be powered at 80% with a 95% one-sided confidence interval, a population of 874 patients would be needed to conclude that the non-irrigation is non-inferior when its infection rate does not exceed by more than 4% the infection rate of the irrigation group. In addition, to account for an attrition rate of approximately 10%, enrolment of 1000 patients is aimed.

Statistical Analysis: Statistical analysis will be done by a certified statistician. According to the distribution of our data, the Chi2 or the Fisher test will be used. A preliminary analysis of our data will be done in the Spring 2017 to assess safety of our intervention.

Plan for Missing Data: Patients that are lost at follow up will be considered as having had no infection if no record of subsequent visits for wound infection is found after consultation of the regional Electronic Medical Record.

Conditions

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Laceration - Injury Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Irrigation

The subjects randomized to this group will have their simple lacerations irrigated with a normal saline solution.

Group Type ACTIVE_COMPARATOR

Irrigation

Intervention Type PROCEDURE

A designated unblinded medical team member (nurse, emergency room physician or resident/trainee uninvolved in that particular patient's care) will prepare the laceration for repair and perform the irrigation. Irrigation will be delivered through a 20 Gauge 1 inch long catheter mounted on a 60 millilitre syringe. The volume of normal saline used will be calculated as 60 millilitre per centimetre length of laceration for a maximum of 300 millilitre. Once completed, the treating physician will enter the room and proceed to the laceration closure with the method and equipment of his choice. Both the patient (through eye covering) and the treating physician will remain blinded to the intervention.

No Irrigation

The subjects randomized to this group will not have their simple lacerations directly irrigated with a normal saline solution.

Group Type EXPERIMENTAL

No irrigation

Intervention Type PROCEDURE

A designated unblinded medical team member (nurse, emergency room physician or resident/trainee uninvolved in that particular patient's care) will prepare the laceration for repair. The laceration will not directly be irrigated. In order to ensure blinding of the subjects, the surrounding of the wound will be irrigated with a total of 60 millilitre of normal saline delivered through a 20 Gauge 1 inch long catheter mounted on a 60 millilitre syringe. Care will be taken not to enter a margin of 5cm from the laceration edges. Once completed, the treating physician will enter the room and proceed to the laceration closure with the method and equipment of his choice. Both the patient (through eye covering) and the treating physician will remain blinded to the intervention.

Interventions

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No irrigation

A designated unblinded medical team member (nurse, emergency room physician or resident/trainee uninvolved in that particular patient's care) will prepare the laceration for repair. The laceration will not directly be irrigated. In order to ensure blinding of the subjects, the surrounding of the wound will be irrigated with a total of 60 millilitre of normal saline delivered through a 20 Gauge 1 inch long catheter mounted on a 60 millilitre syringe. Care will be taken not to enter a margin of 5cm from the laceration edges. Once completed, the treating physician will enter the room and proceed to the laceration closure with the method and equipment of his choice. Both the patient (through eye covering) and the treating physician will remain blinded to the intervention.

Intervention Type PROCEDURE

Irrigation

A designated unblinded medical team member (nurse, emergency room physician or resident/trainee uninvolved in that particular patient's care) will prepare the laceration for repair and perform the irrigation. Irrigation will be delivered through a 20 Gauge 1 inch long catheter mounted on a 60 millilitre syringe. The volume of normal saline used will be calculated as 60 millilitre per centimetre length of laceration for a maximum of 300 millilitre. Once completed, the treating physician will enter the room and proceed to the laceration closure with the method and equipment of his choice. Both the patient (through eye covering) and the treating physician will remain blinded to the intervention.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* age 18 or older
* repair within 18 hours from time of injury
* repair done by the emergency room physician or trainee
* clean and simple lacerations (clean edge with no gross contamination, as assessed by the treating physician)

Exclusion Criteria

* pregnant patients
* involving tendons, muscles, fascias, articulations
* located on the ear, nose or distal to metacarpophalangeal or metatarsophalangeal joint
* immunosuppressed (neutropenia, chronic corticotherapy, HIV, immunosuppressive therapy within 3 months)
* bite wounds
* lacerations with any loss of substance
* lacerations with foreign body
* complex lacerations (crush, stellate)
* grossly contaminated
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Agence de la Sante et des Services Sociaux du Saguenay-Lac-Saint-Jean

OTHER

Sponsor Role collaborator

Université de Sherbrooke

OTHER

Sponsor Role lead

Responsible Party

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Julien Bouchard

MD, CCFP(EM)

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Julien Bouchard, MD, CCFP(EM)

Role: PRINCIPAL_INVESTIGATOR

Université de Sherbrooke

Locations

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CIUSSS Saguenay-Lac-St-Jean, Hôpital de Chicoutimi

Chicoutimi, Quebec, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Julien Bouchard, MD, CCFP(EM)

Role: CONTACT

418-541-1000

Facility Contacts

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Julien Bouchard, MD, CCFP(EM)

Role: primary

418-541-1000

Antoine Herman-Lemelin, MD, CCFP(EM)

Role: backup

Sébastien Lefebvre, MD, CCFP(EM)

Role: backup

Catherine Desmeules, MD

Role: backup

Jillian Follett, MD

Role: backup

Alexandre Sauvé, MD

Role: backup

Laurence Tremblay, MD

Role: backup

References

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Dire DJ, Welsh AP. A comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med. 1990 Jun;19(6):704-8. doi: 10.1016/s0196-0644(05)82484-9.

Reference Type BACKGROUND
PMID: 2344089 (View on PubMed)

Moscati R, Mayrose J, Fincher L, Jehle D. Comparison of normal saline with tap water for wound irrigation. Am J Emerg Med. 1998 Jul;16(4):379-81. doi: 10.1016/s0735-6757(98)90133-4.

Reference Type BACKGROUND
PMID: 9672456 (View on PubMed)

Moscati RM, Mayrose J, Reardon RF, Janicke DM, Jehle DV. A multicenter comparison of tap water versus sterile saline for wound irrigation. Acad Emerg Med. 2007 May;14(5):404-9. doi: 10.1197/j.aem.2007.01.007.

Reference Type BACKGROUND
PMID: 17456554 (View on PubMed)

Griffiths RD, Fernandez RS, Ussia CA. Is tap water a safe alternative to normal saline for wound irrigation in the community setting? J Wound Care. 2001 Nov;10(10):407-11. doi: 10.12968/jowc.2001.10.10.26149.

Reference Type BACKGROUND
PMID: 12964289 (View on PubMed)

Bansal BC, Wiebe RA, Perkins SD, Abramo TJ. Tap water for irrigation of lacerations. Am J Emerg Med. 2002 Sep;20(5):469-72. doi: 10.1053/ajem.2002.35501.

Reference Type BACKGROUND
PMID: 12216046 (View on PubMed)

Valente JH, Forti RJ, Freundlich LF, Zandieh SO, Crain EF. Wound irrigation in children: saline solution or tap water? Ann Emerg Med. 2003 May;41(5):609-16. doi: 10.1067/mem.2003.137.

Reference Type BACKGROUND
PMID: 12712026 (View on PubMed)

Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. 2012 Feb 15;(2):CD003861. doi: 10.1002/14651858.CD003861.pub3.

Reference Type BACKGROUND
PMID: 22336796 (View on PubMed)

Stevenson TR, Thacker JG, Rodeheaver GT, Bacchetta C, Edgerton MT, Edlich RF. Cleansing the traumatic wound by high pressure syringe irrigation. JACEP. 1976 Jan;5(1):17-21. doi: 10.1016/s0361-1124(76)80160-8.

Reference Type BACKGROUND
PMID: 933383 (View on PubMed)

Hollander JE, Richman PB, Werblud M, Miller T, Huggler J, Singer AJ. Irrigation in facial and scalp lacerations: does it alter outcome? Ann Emerg Med. 1998 Jan;31(1):73-7. doi: 10.1016/s0196-0644(98)70284-7.

Reference Type BACKGROUND
PMID: 9437345 (View on PubMed)

Hollander JE, Singer AJ, Valentine S. Comparison of wound care practices in pediatric and adult lacerations repaired in the emergency department. Pediatr Emerg Care. 1998 Feb;14(1):15-8. doi: 10.1097/00006565-199802000-00004.

Reference Type BACKGROUND
PMID: 9516624 (View on PubMed)

Maharaj D, Sharma D, Ramdass M, Naraynsingh V. Closure of traumatic wounds without cleaning and suturing. Postgrad Med J. 2002 May;78(919):281-2. doi: 10.1136/pmj.78.919.281.

Reference Type BACKGROUND
PMID: 12151570 (View on PubMed)

Webster DJ, Davis PW. Closure of abdominal wounds by adhesive strips: a clinical trial. Br Med J. 1975 Sep 20;3(5985):696-8. doi: 10.1136/bmj.3.5985.696.

Reference Type BACKGROUND
PMID: 1100188 (View on PubMed)

Rodeheaver GT, Pettry D, Thacker JG, Edgerton MT, Edlich RF. Wound cleansing by high pressure irrigation. Surg Gynecol Obstet. 1975 Sep;141(3):357-62.

Reference Type BACKGROUND
PMID: 808870 (View on PubMed)

Longmire AW, Broom LA, Burch J. Wound infection following high-pressure syringe and needle irrigation. Am J Emerg Med. 1987 Mar;5(2):179-81. doi: 10.1016/0735-6757(87)90121-5. No abstract available.

Reference Type BACKGROUND
PMID: 3828025 (View on PubMed)

Pronchik D, Barber C, Rittenhouse S. Low- versus high-pressure irrigation techniques in Staphylococcus aureus-inoculated wounds. Am J Emerg Med. 1999 Mar;17(2):121-4. doi: 10.1016/s0735-6757(99)90041-4.

Reference Type BACKGROUND
PMID: 10102307 (View on PubMed)

Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic lacerations. N Engl J Med. 1997 Oct 16;337(16):1142-8. doi: 10.1056/NEJM199710163371607. No abstract available.

Reference Type BACKGROUND
PMID: 9329936 (View on PubMed)

Hollander JE, Singer AJ. Laceration management. Ann Emerg Med. 1999 Sep;34(3):356-67. doi: 10.1016/s0196-0644(99)70131-9.

Reference Type BACKGROUND
PMID: 10459093 (View on PubMed)

Nicks BA, Ayello EA, Woo K, Nitzki-George D, Sibbald RG. Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations. Int J Emerg Med. 2010 Aug 27;3(4):399-407. doi: 10.1007/s12245-010-0217-5.

Reference Type BACKGROUND
PMID: 21373312 (View on PubMed)

Other Identifiers

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2016-025

Identifier Type: -

Identifier Source: org_study_id

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